Give patients protection from surprise medical bills

Jennifer Saurenman of San Marino meticulously planned a shoulder surgery last year. She spent weeks ensuring her surgeon and the outpatient facility were in her health insurance plan’s network.

But she couldn’t find out who her anesthesiologist would be until the day of the procedure, and she was hit with a $4,230 bill for an out-of-network anesthesiologist.

Her story is, unfortunately, far too common in California. A 2015 survey by the Consumer Reports National Research Center found that nearly one in four privately insured Californians received a surprise medical bill where their health plan paid less than expected. Saurenman questioned her bill and ultimately paid only $500, but that’s not the norm. The same survey found that 60 percent of those with higher-than-expected bills had to pay the bill in full.

Last year’s effort to fix this problem failed by just three votes in the final hours of the legislative session. Now, a carefully crafted, bipartisan bill – Assembly Bill 72 – offers another chance to do right by consumers.

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Before the Senate, AB 72, by Assemblyman Rob Bonta, an Oakland Democrat, would protect patients from surprise medical bills in non-emergency situations, and establish a streamlined process for doctors to sort out reimbursement issues with insurers. Consumers would only be responsible for their in-network cost sharing, and their expenses would count toward their in-network deductible and out-of-pocket maximum. Providers would be prohibited from sending consumers outrageous out-of-network bills from doctors they did not choose.

In emergency situations, California already has protections against “balance billing” – when a health provider bills the patient for the balance of their bill that insurers do not reimburse.

Such bills can total tens of thousands of dollars, an alarming threat given a recent report from the Federal Reserve indicating that nearly half of U.S. households would have trouble meeting emergency expenses of just $400.

A recent Kaiser Family Foundation survey found that 61 percent of those with medical bill problems say they have had difficulty paying other bills as a result, and 35 percent were unable to pay for necessities such as food or housing. Medical debt can also destroy consumers’ credit for years, making it difficult to secure mortgages, credit cards or other financial services.

It’s time to spare consumers who have done everything right from the reimbursement battle between insurance companies and out-of-network doctors. That’s why Consumers Union strongly supports AB 72.

Industry groups have powerful lobbyists to speak up for them, but legislators should speak up for consumers and put an end to surprise medical bills.

Betsy Imholz is special projects director for Consumers Union, the policy and advocacy arm of Consumer Reports. She can be contacted at bimholz@consumer.org.